Case 3 History ---- The patient was a 1280 gm 30 week gestational product of a 22 year old mother and was the 3rd baby of a triplet pregnancy. The child developed respiratory distress (RDS) within a short time after birth. Neurologic exam demonstrated poor tone throughout, few spontaneous movements, and weak suck and grasp reflexes. Due to cyanosis and respiratory distress syndrome an ET tube was placed and the patient was started on 100% 02 which led to improvement in respiratory function. Bilirubin started to increase almost immediately and reached 8.0 on 3/22. Following an LP the patient’s heart rate dropped but responded to brief bagging and stimulation. Later that day the baby appeared more lethargic. Over the next 3 days, the major medical problems were hypocalcemia treated with intravenous calcium drip, possible sepsis, rising BUN, and persistent problems with RDS. The bilirubin continued to increase and on April 3 reached levels of total bilirubin of 21 (12.8 direct) continuing to increase with a total of 29.8 (direct 11.6). The baby died at the age of 23 days.
At autopsy a large mass of clotted blood filled the right cerebral lateral ventricle, extending from the anterior horn caudally to the trigone. Subarachnoid hemorrhage involved the temporal poles and the leptomeninges at the base of the brain.
